NACCHO Croakey Health Wrap: the tobacco stain, wicked obesity problems, a new Aboriginal health vision and more



This week’s Health Wrap has been prepared by Melissa Davey, former SMH journalist, prolific tweeter and keen public health observer who has joined me at the Sax Institute in the new role of Communications Manager.

This expansion of the Croakey Health Wrap team is well timed given the amount of health news being produced and debated. This past fortnight, tobacco was on the agenda, there were some interesting discussions on obesity and the Federal Government unveiled its new vision for Aboriginal health.


Our thanks to Melissa Sweet and Melissa Davey

Responses to new Indigenous health plan

Drawing attention to Aboriginal health is difficult when the launch of the National Aboriginal Torres Strait Islander Health Plan falls on the same day of the birth of a new Royal, writes Colin Cowell for Croakey. The plan aims to provide an evidence-based framework to guide policy. Priorities identified include Aboriginal social and emotional wellbeing and the factors influencing it, including drugs and alcohol.

“The plan has also resolved to tackle the difficult and distressing issues of violence, abuse and self-harm,” Cowell writes. “Importantly, in this plan the sector has signalled the need to expand our focus on children’s health to broader issues in child development. There is also much work to do in developing robust research and data systems. The plan has also resolved to tackle the difficult and distressing issues of violence, abuse and self-harm.”

Bridie Jabour for the Guardian details how the Federal Government has pushed ahead with the plan despite the June 30 deadline for signing the Closing the Gap agreement on Indigenous health being missed. However, Victoria has since put forward its own funding offer.

A culturally appropriate screening tool that can gauge Indigenous social and emotional wellbeing may be one solution to help determine patients with mental health concerns or who need referring on for evaluation, writes Marnie McKimmie in The West Australian.

And about 120 Aboriginal men came together recently at at Ross River, 100 km east of Alice Springs, to identify ways of better targeting men in remote communities. (The location of the meeting has been corrected from an earlier version of this post). Indigenous health minister, Warren Snowden said, “Rather than having Aboriginal and Torres Strait Islander people feel like they are part of the problem, we want to encourage and support Aboriginal men to be a part of the solution”. A national summit on Aboriginal and Torres Strait Islander health was also held in Melbourne.

As NAIDOC week drew to a close, 10 Indigenous Australians were honoured at the NAIDOC award ceremony in Perth. ABC reported the story here.

And in an update on closing the gap in Indigenous health for Croakey, health policy analyst Dr Lesley Russell hopes Prime Minister Kevin Rudd sees formal funding agreements with the states and territories as “part of the unfinished business that must be taken off his desk before the election is called”.

Elizabeth Strakosch is particularly scathing of the lack of progress in Indigenous health from both sides of politics in this piece for The Conversation.


Tobacco reform: evidence takes a back seat

The UK Government’s backflip on plans to introduce plain packaging of tobacco has attracted widespread criticism from public health experts over the past couple of weeks. The Conservative party’s chief strategist, Lynton Crosby, has previously said issues like immigration and the economy should be the focus of government, with health barely rating a mention. His stance is perhaps not surprising, given this New Statesman report that his lobbying company has close links to the tobacco industry. Conservative MP Philip Davies also said introducing plain packaging in the UK would be “gesture politics” with “no basis in evidence”.

Writing for The Conversation, Assistant Professor at the University of Michigan Holly Jarman says it’s looking like the policy is dead in the water. Her comments were prompted by an announcement from Health Secretary Jeremy Hunt that the UK Government had decided to wait until the impact of plain packaging in Australia could be measured before acting. But Professor Jarman refers to numerous studies that indicate plain packaging is effective. “The evidence base for plain packaging is arguably better than that for many other policies currently being pursued by the government,” she says.

New research published in the online medical journal BMJ Open also concludes plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers. It’s the first study to examine the effect of Australia’s plain packaging reforms on the attitudes of smokers. Tobacco control advocate and professor of public health Simon Chapman shares his thoughts on the study for The Conversation.

Meanwhile, a Guardian editorial sums the UK Government’s public health policy like this: “Squint for long enough at the remains of the coalition’s policies to help Britons live longer, healthier lives, and it might appear that ministers really believe multinational tobacco businesses and FTSE-listed retailers deserve greater protection than parents doing the school run.”

Another blow to the “not enough evidence” argument comes from the World Health Organization, which released a report on the global tobacco epidemic describing bans on tobacco advertising, promotion and sponsorship as one of six measures known to be protective against tobacco’s effects. And packaging is a key platform for that advertising and promotion.

The Telegraph’s Tom Chivers, however, is not convinced the freedom of tobacco companies to sell cigarettes in one coloured pack or another is particularly important.


Obesity: a wicked problem

Perhaps some Australians are getting the message to cut back on fast food with this report from Eli Greenblat that McDonald’s sales in Australia are going backwards. However McDonald’s president, Don Thompson, appears to have fudged youth unemployment figures to explain the decline in sales. “Youth unemployment in Australia is about 25.5 per cent,” he is quoted as saying. “So they’re facing something; unemployment for them has risen.” In fact, youth unemployment was at 11.6% as of May.

But even if our taste for some fast foods has dropped it is well known that portion sizes are growing. Senior Lecturer at the University of NSW Lenny Vartanian says people eat large portions even if they are not very hungry or if the food doesn’t taste that good. Writing for The Conversation, he also says education about portion size alone may not be enough to help people to eat more mindfully.

One tactic that definitely doesn’t help people lose weight is weight discrimination, a study published online by PLoS One has found. Not only does it lead to poorer mental health outcomes, but discrimination increases risk of obesity rather than motivating people to lose weight, the study found. Cat Pause offers a good analysis of the issues here.

The obesity epidemic here has attracted the attention of the US media. This excellent analysis by The New York times reports the prevalence of obesity is growing faster in Australia than any other industrialised nation. It also gives an overview of the various strategies state and territory governments have tried to tackle the problem. But the report says these campaigns may not be enough, with obesity rates projected to rise across all age groups in Australia for the next decade.


System strife

More than 5000 NSW nurses and midwives went on strike this week, saying patient care had been compromised because of a lack of clinical staff to treat them. In the Sydney Morning Herald, Lucy Carroll writes that the NSW Midwives and Nurses Association wants one nurse for every four patients in general medical, surgical and mental health wards. It also wants one nurse for every three patients in general children’s wards and in emergency departments.

The NSW branch of the Australian Medical Association was among those to lend support to the action. In a statement their president, Associate Professor Brian Owler, says nurse-to-patient ratios have provided a sound basis for improving staffing levels in major hospitals and should be extended to hospitals more generally. He says hospitals are often staffed on the basis of historical funding levels rather than patient need, which means western and outer metropolitan Sydney hospitals are understaffed compared to those in the CBD.

And with Health Workforce Australia predicting a shortfall of nearly 110,000 nurses by 2025, University of Sydney vice-chancellor, Dr Michael Spence says the Federal Government’s proposed $2000 cap on self-education tax deductions for the health and medical workforce is a bad move. He’s not alone. The cap has attracted significant attention and a good debate on the issue can be found at The Conversation.

Meanwhile Sean Nicholls writes in the SMH that paramedics are plagued by inappropriate emergency call-outs for “ailments” such as bed-bugs, leech bites, scraped knees and even light bulb changes.

It’s a problem exacerbated by current protocols which require paramedics to take patients to hospital if the patient insists, the NSW Auditor General Peter Acherstraat reports. He found only 65% of ambulance crews handed over patients within 30 minutes of arriving at hospital, well below NSW Health’s target of 90 per cent.

Doctors in Queensland seem to be having an easier time of it, if this report from is to be believed, which found senior public hospital doctors are being paid $100,000 to do nothing.

At the federal level, The Drum and Croakey ask: whatever happened to the health debate? In the latter piece, Croakey co-ordinator Melissa Sweet says health policy is unlikely be a vote-swinger come the federal election, despite the AMA doing its bit to drum up interest. It has released its health policy platform – available here. Affordable healthcare and rural and Aboriginal health are key areas on their agenda, reports.


Vaccination supporters get vocal

Confirmation that actress and anti-vaxxer Jenny McCarthy will be appointed as a panellist on popular US day-time talk show The View, has Toronto Public Health in Canada up in arms. As reports, they have launched a campaign against her hire by the ABC. And National Public Radio in the US aired this podcast called ‘A Dangerous View’ that gives a great overview of the controversy surrounding her hiring.

Back in Australia, anti-vax lobby group the Australian Vaccination Network has been dealt a blow. Medical Observer reports the group had been using comments made by former Greens leader Bob Brown to promote their cause. But in an open letter, Brown says his view has always been that vaccination is in the interests of public health and should be promoted.

NSW Opposition leader John Robertson meanwhile, has accused the State Government of making its new policy on vaccinating mothers against whooping cough confusing. The changes mean NSW Health will no longer provide free whooping cough vaccine to GPs for mothers after they have given birth. Explaining the changes, NSW Health Director of Communicable Diseases Dr Vicky Sheppeard says to be most effective the vaccine needs to be given before the baby is born.“Research by NSW Health and the National Centre for Immunisation Research and Surveillance confirms it’s best to get vaccinated before conception, during the third trimester of pregnancy or failing that, at soon as possible after delivery,” Dr Sheppeard says.

***  Research and pharma

Australians are abusing and becoming dependent on a wider range of opioids, reports Shevonne Hunt for the ABC. Shevonne’s report highlights a presentation at the International Narcotics Research Conference in which Professor Paul Haber showed a continuous rise in the use of oxycodone over the past three years, while fentanyl and buprenorphine use are also rising. “Instead of having an epidemic of one prescription opioid we’re in the midst of an epidemic of three,” he says.

In other research news, the Guardian health editor Sarah Boseley reports alcohol-related deaths of UK women in their 30s and 40s are steadily rising. Late night drinking culture, cheap alcohol and industry marketing and promotion had all played a part, researchers found – these are also issues for Australia, Fairfax reports.

In international research, a study linking the consumption of fatty acids found in fish with increased prostate cancer risk has been widely written about, read and criticised. The Inquisitr examines the views of some of the critics of the study. David Katz sits more in the middle, writing for the Huffington Post that while the study does not prove that fish oil intake causes prostate cancer, it was not “dismissible rubbish”.

Also on the Huffington Post is this piece from neurologist Aysha Akhtar, who argues animals should not be used in medical research because they are not good ‘models’ of human physiology. “Over one hundred stroke drugs have been found effective in animals in the lab, yet all have failed in humans,’’ she writes. “Over 85 HIV vaccines that worked in non-human primates failed miserably when tried in humans.”

Another controversial topic this fortnight was male fertility, after an analysis from France found the sperm concentration of men had decreased by one third between 1989 and 2005. It led fertility experts attending the European Society of Human Reproduction and Embryology conference to debate whether male fertility is on the decline, The Wall Street Journal reports.

In women’s health, researchers from the University of NSW have found in a major study that women may not need a pap smear every two years. In their review of 20 years’ worth of data from Australia, New Zealand and England, they found women screened every three years had a similar rate of cervical cancer and deaths compared to those screened more regularly, the ABC reports.

And in the New York Times, Clifton Leaf questions clinical trials, examining some of the issues that plague them.


E-health flaws

Sensitive and confidential medical data belonging to nearly 3000 patients was found on a computer sold by the National Health Service in England through an auction site. The Service was fined 200,000 pounds for the data breach, ehealth Insider reports.

And in Australia, 6Minutes reports e-records are still a long way from benefiting GPs. It comes as the Federal Health Minister Tanya Plibersek announced $8 million towards developing software to enable pathology and radiology results to be sent to the patient’s personally controlled electronic health record, as well as to their GP.


What doctors won’t do

Only 11% of doctors who responded to a recent Australian Doctor survey said they would want to be kept alive after a major accident. And one third of male GPs would shun PSA screening for prostate cancer. Check out @australiandr who is tweeting results from their survey of GPs about the medical treatments they would never want to undergo themselves.


Other Croakey reading you may have missed this fortnight: * This is worth reading (hope I’ve convinced you) * From the FOI archives: “Outcome sought – that Ministers quietly note the plan and nothing else happens” * What does $895 buy when it comes to Liberal Party health policy? * Q: How often should you see a dentist? The answer may make you :)

You can find previous editions of the Health Wrap here.

Twitter shout-outs this week go to: @LRussellWolpe, @lucy_carroll, @australiandr, @cancerNSW, @picardonhealth, @DrHWoo, @SimonChapman6, @curious_scribe, @upulie, @richardhorton1

Melissa Davey is the Sax Institute’s Communications Manager. She was previously a health and medical reporter for the Sydney Morning Herald and the Sun Herald. She is completing her Masters of Public Health at the University of Sydney and has a strong interest in public health messaging and mental health. The Sax Institute is a not-for-profit organisation that drives the use of research evidence in health policy and planning. Twitter: @MelissaLDavey

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